Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants
BackgroundBronchopulmonary dysplasia (BPD) is a common complication in extremely preterm infants (EPIs), and there is currently a lack of effective preventive strategies. Identifying risk factors may facilitate early interventions and improve outcomes.ObjectiveTo investigate risk factors for the occ...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1629279/full |
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| author | Xuejing Liu Xuejing Liu Xuejing Liu Wanxian Zhang Wanxian Zhang Wanxian Zhang Fangrui Ding Fangrui Ding Fangrui Ding |
| author_facet | Xuejing Liu Xuejing Liu Xuejing Liu Wanxian Zhang Wanxian Zhang Wanxian Zhang Fangrui Ding Fangrui Ding Fangrui Ding |
| author_sort | Xuejing Liu |
| collection | DOAJ |
| description | BackgroundBronchopulmonary dysplasia (BPD) is a common complication in extremely preterm infants (EPIs), and there is currently a lack of effective preventive strategies. Identifying risk factors may facilitate early interventions and improve outcomes.ObjectiveTo investigate risk factors for the occurrence and severity of BPD in EPIs and inform potential prevention strategies.MethodsWe conducted a retrospective analysis of medical records from EPIs admitted to the neonatal intensive care unit at Tianjin Central Hospital of Obstetrics and Gynecology between 2012 and 2024. BPD was diagnosed according to the 2018 revised criteria established by the National Institute of Child Health and Human Development. Multivariable logistic regression was used to identify independent risk factors.ResultsAmong 468 EPIs, 136 (29.1%) developed BPD (mild: 14.1%, moderate: 7.1%, severe: 7.9%). Independent risk factors for BPD included prolonged invasive mechanical ventilation (IMV, OR = 1.10, 95% CI 1.03–1.17), frequent red blood cell transfusions (RBCTs, OR = 1.61, 95% CI 1.30–2.01), extended antibiotic exposure (OR = 1.03, 95% CI 1.01–1.06), and hemodynamically significant patent ductus arteriosus (hsPDA, OR = 2.27, 95% CI 1.22–4.20). Prolonged IMV (OR = 1.16, 95% CI 1.06–1.27) and higher fluid balance (FB) on postnatal day 7 (OR = 1.19, 95% CI 1.05–1.34) were independent risk factors for moderate-to-severe BPD, while higher birth weight (OR = 0.99, 95% CI 0.988–0.998) was found to be a protective factor. Whole blood transfusion was associated with an increased risk of BPD (OR = 4.48, 95% CI 1.92–10.43) and moderate-to-severe BPD (OR = 4.81, 95% CI 1.24–18.63) compared to packed RBCTs. In predicting moderate-to-severe BPD, the duration of IMV (cut-off: 6.5 days) and FB on postnatal day 7 (cut-off: −7.2) demonstrated significant predictive value.ConclusionsIn conclusion, the occurrence and severity of BPD in EPIs are influenced by prolonged IMV, frequent RBCTs, fluid overload, excessive antibiotic exposure, and hsPDA. Early interventions targeting modifiable factors, such as reducing IMV duration, maintaining an appropriate negative FB on postnatal day 7, and optimizing transfusion protocols, are critical to prevent moderate-to-severe BPD. |
| format | Article |
| id | doaj-art-2a17d8f12d77413b933528a6f9a43a3b |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-2a17d8f12d77413b933528a6f9a43a3b2025-08-20T03:03:58ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-08-011310.3389/fped.2025.16292791629279Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infantsXuejing Liu0Xuejing Liu1Xuejing Liu2Wanxian Zhang3Wanxian Zhang4Wanxian Zhang5Fangrui Ding6Fangrui Ding7Fangrui Ding8Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaDepartment of Neonatology, Nankai University Affiliated Maternity Hospital, Tianjin, ChinaTianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaDepartment of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaDepartment of Neonatology, Nankai University Affiliated Maternity Hospital, Tianjin, ChinaTianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaDepartment of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaDepartment of Neonatology, Nankai University Affiliated Maternity Hospital, Tianjin, ChinaTianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, ChinaBackgroundBronchopulmonary dysplasia (BPD) is a common complication in extremely preterm infants (EPIs), and there is currently a lack of effective preventive strategies. Identifying risk factors may facilitate early interventions and improve outcomes.ObjectiveTo investigate risk factors for the occurrence and severity of BPD in EPIs and inform potential prevention strategies.MethodsWe conducted a retrospective analysis of medical records from EPIs admitted to the neonatal intensive care unit at Tianjin Central Hospital of Obstetrics and Gynecology between 2012 and 2024. BPD was diagnosed according to the 2018 revised criteria established by the National Institute of Child Health and Human Development. Multivariable logistic regression was used to identify independent risk factors.ResultsAmong 468 EPIs, 136 (29.1%) developed BPD (mild: 14.1%, moderate: 7.1%, severe: 7.9%). Independent risk factors for BPD included prolonged invasive mechanical ventilation (IMV, OR = 1.10, 95% CI 1.03–1.17), frequent red blood cell transfusions (RBCTs, OR = 1.61, 95% CI 1.30–2.01), extended antibiotic exposure (OR = 1.03, 95% CI 1.01–1.06), and hemodynamically significant patent ductus arteriosus (hsPDA, OR = 2.27, 95% CI 1.22–4.20). Prolonged IMV (OR = 1.16, 95% CI 1.06–1.27) and higher fluid balance (FB) on postnatal day 7 (OR = 1.19, 95% CI 1.05–1.34) were independent risk factors for moderate-to-severe BPD, while higher birth weight (OR = 0.99, 95% CI 0.988–0.998) was found to be a protective factor. Whole blood transfusion was associated with an increased risk of BPD (OR = 4.48, 95% CI 1.92–10.43) and moderate-to-severe BPD (OR = 4.81, 95% CI 1.24–18.63) compared to packed RBCTs. In predicting moderate-to-severe BPD, the duration of IMV (cut-off: 6.5 days) and FB on postnatal day 7 (cut-off: −7.2) demonstrated significant predictive value.ConclusionsIn conclusion, the occurrence and severity of BPD in EPIs are influenced by prolonged IMV, frequent RBCTs, fluid overload, excessive antibiotic exposure, and hsPDA. Early interventions targeting modifiable factors, such as reducing IMV duration, maintaining an appropriate negative FB on postnatal day 7, and optimizing transfusion protocols, are critical to prevent moderate-to-severe BPD.https://www.frontiersin.org/articles/10.3389/fped.2025.1629279/fullextremely premature infantsbronchopulmonary dysplasiainvasive mechanical ventilationtransfusionfluid balanceantibiotics |
| spellingShingle | Xuejing Liu Xuejing Liu Xuejing Liu Wanxian Zhang Wanxian Zhang Wanxian Zhang Fangrui Ding Fangrui Ding Fangrui Ding Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants Frontiers in Pediatrics extremely premature infants bronchopulmonary dysplasia invasive mechanical ventilation transfusion fluid balance antibiotics |
| title | Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| title_full | Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| title_fullStr | Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| title_full_unstemmed | Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| title_short | Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| title_sort | predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants |
| topic | extremely premature infants bronchopulmonary dysplasia invasive mechanical ventilation transfusion fluid balance antibiotics |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1629279/full |
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